Missed Hypertension in Adolescents & Risk of ESRD

Persistent hypertension in adulthood is a leading cause of end-stage renal disease (ESRD). Whether lower blood pressure (BP) values, in the range of prehypertension, are also associated with future occurrence of ESRD is unclear. A recent study published in Journal of Hypertension clearly shows that asymptomatic, healthy adolescents with prehypertension have a 32% increased risk for subsequent ESRD, compared with adolescents with optimal BP.

The fourth report clearly shows that the long-term health risks for hypertensive children and adolescents can be substantial; therefore, it is important that clinical measures be taken to reduce these risks and optimize health outcomes.

MEASUREMENT OF BP IN CHILDREN

• Children >3 years old who are seen in a medical setting should have their BP measured.

• The preferred method of BP measurement is auscultation.

  Conditions Under Which Children <3 Years Old Should Have BP Measured

  – History of prematurity, very low birth weight, or other neonatal complication requiring intensive care

  – Congenital heart disease (repaired or nonrepaired)

  – Recurrent urinary tract infections, hematuria, or proteinuria

  – Known renal disease or urologic malformations

  – Family history of congenital renal disease

  – Solid-organ transplant

  – Malignancy or bone marrow transplant

  – Treatment with drugs known to raise BP

  – Other systemic illnesses associated with hypertension (neurofibromatosis, tuberous sclerosis, etc)

  – Evidence of elevated intracranial pressure